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Disclosing adverse events to patients
Michael D Cantor1, Paul Barach, Arthur Derse
1VA New England Geriatric Research, Education, and Clinical Center, Boston, USA.
Joint Commission Journal on Quality and Patient Safety
|February 5, 2005
Summary
The Veterans Health Administration recommends routine disclosure of adverse events to patients. Clear policies and supportive environments are crucial for clinicians to fulfill their ethical obligations.
Area of Science:
- Medical Ethics
- Patient Safety
- Healthcare Policy
Background:
- Examines the rationale and recommended approaches for disclosing adverse events to patients.
- Draws upon the experience of the Veterans Health Administration (VHA).
- VHA's National Ethics Committee advocates for routine disclosure and provides implementation guidance.
Purpose of the Study:
- To outline the ethical imperative and practical strategies for disclosing adverse events.
- To encourage the adoption of disclosure policies within healthcare organizations.
Main Methods:
- Policy review and ethical analysis based on VHA experience.
- Identification of specific criteria necessitating disclosure of adverse events.
- Discussion of factors influencing clinician and organizational reluctance.
Main Results:
- Disclosure is mandated when adverse events have perceptible effects not previously discussed, require care changes, pose future health risks, or occur without consent.
- Disclosure is ethically required regardless of injury severity.
- Disclosure of near misses is discretionary but often advisable.
Conclusions:
- Compelling ethical arguments support routine disclosure of adverse events.
- Healthcare organizations must establish clear disclosure policies.
- Creating supportive environments is essential for clinicians to meet disclosure obligations.
Keywords:
Health Care and Public Health